By: Evans Osei-Bonsu- Head of the Department of Economics at the Kwame Nkrumah University of Science and Technology (KNUST), Professor Eric Fosu Oteng-Abayie, has warned that Ghana’s new agreement with Grenada for the recruitment of experienced nurses represents “a profoundly shortsighted policy” that could “systematically weaken the very foundation of Ghana’s public health system.”
In a strongly worded critique titled “The Strategic Depletion of Ghana’s Health Sector Human Capital: An Economic Critique,” Prof. Oteng-Abayie described the policy as “a profoundly shortsighted decision” that could “systematically weaken the very foundation of Ghana’s public health system.”
Professor Oteng-Abayie argues that the arrangement, which seeks to recruit nurses with at least five years’ experience, “is not a simple labour exchange; it is a state-sanctioned acceleration of human capital flight, strategically targeting the sector’s most valuable and experienced assets.”
According to him, the policy “moves this from a concerning trend to a calculated depletion of institutional strength, with long-term economic consequences that far outweigh any short-term, individual gains.”
Professor Oteng-Abayie described the initiative as economically unsound, explaining that the Ghanaian state has already made substantial investments in training and developing these professionals. “A newly qualified nurse represents a significant public investment in education and training. An experienced nurse, however, represents that initial investment compounded by years of on-the-job training, mentorship, and exposure to complex clinical situations,” he stated.
“The Ghanaian state, through its subsidized training colleges and teaching hospitals, has borne the full cost of their formative, lower-productivity years,” he wrote, adding that the decision to export nurses with five years of experience means “they are leaving precisely at the moment they transition from a net cost to a net benefit for the system.”
He warned that the arrangement effectively makes Ghana “subsidize the health system of Grenada,” noting that “we are gifting a fully formed, high-value human asset and receiving nothing in return but the daunting and recurrent cost of recruiting and training a replacement.”
Professor Oteng-Abayie described this as “a catastrophic negative return on investment for the Ghanaian public purse.” He wrote, “The nurse’s most valuable years of service—their peak earning years for the state in terms of productivity and social value—are exported, truncating the investment cycle and transforming a public good into a temporary commodity for export.”
Beyond the financial implications, he emphasized the “destructive multiplier effect” that the loss of experienced nurses will have on the health system. “The departure of experienced nurses creates a critical mentorship vacuum. One experienced nurse in a unit like Accident & Emergency typically supervises and shapes the clinical competencies of several junior colleagues. Their departure doesn’t just create one vacancy; it actively degrades the training environment for all new entrants,” he warned.
He further stated that such departures “erode institutional memory,” as experienced nurses “hold the tacit knowledge of the system—the unwritten protocols, the nuanced decision-making skills for complex cases, and the informal networks that ensure operational efficiency.” He warned that their exit would lead to “systemic clumsiness, increased administrative friction, and a decline in the overall quality of care.”
The professor also cautioned against the message such agreements send to the next generation of Ghanaian health professionals. “It officially legitimizes the notion that the pinnacle of a Ghanaian nurse’s career is to leave the country,” he observed. “It establishes a clear, government-facilitated pathway that tells our most ambitious and capable health professionals that their hard-won, state-subsidized experience is not a building block for our own national health system, but a ticket out.”
He argued that this signal “undermines long-term workforce planning and makes a mockery of domestic retention strategies,” adding that it “reshapes the career aspirations of the next generation of health workers, guiding them toward exit from the very outset of their professional journeys.”
Responding to the argument that such agreements boost remittance inflows, Professor Oteng-Abayie dismissed it as “a classic case of mistaking microeconomic private gain for macroeconomic public benefit.” He wrote, “The money sent home by a few hundred nurses, while beneficial to their immediate families, does not rebuild a collapsed intensive care unit, pay the salaries of their replacements, or mentor new graduates. It is a private transfer that cannot compensate for the degradation of a public good.”
He also described the notion of a surplus of nurses as “economically illiterate,” noting that “there is no surplus of experienced, specialized nurses in Ghana; there is a critical shortage, evidenced by chronic understaffing in key units, reliance on overtime, and the ongoing struggle to staff new facilities.”
“The policy does not alleviate a surplus,” he warned, “it actively creates a more severe deficit in the most critical and difficult-to-fill positions, driving up the long-term cost of healthcare delivery for the entire nation.”
Calling for a complete reorientation of Ghana’s labour policy, Professor Oteng-Abayie urged government to move from “extraction to retention.” He stressed that “a rational and strategic national labour policy would seek to protect and nurture its most valuable human assets, not facilitate their extraction.”
“The existence of this state-sanctioned recruitment drive is an admission of failure in addressing the root causes of health worker dissatisfaction,” he said, urging the state to instead invest in “competitive, experience-based salary structures, significant improvement in working conditions and infrastructure, and clear, rewarding career pathways.”
He concluded that the Ghana–Grenada nursing deal is “a textbook example of a zero-sum policy that sacrifices long-term national interest for short-term political optics.”
“The economic logic is unequivocal,” Professor Oteng-Abayie warned. “The private gains for the individual nurses who emigrate are overwhelmingly outweighed by the profound public losses for the Ghanaian health system and the broader economy.”
“We are not exporting a surplus commodity,” he wrote. “We are liquidating the essential human capital upon which public health, national productivity, and future economic growth depend.”
“To continue on this path is to preside over the managed decline of a vital public institution,” he concluded. “It is a policy of strategic depletion, and it must be re-evaluated before the damage to our health system becomes irreversible. The true measure of a nation’s commitment to health is not in the opportunities it creates for its workers to leave, but in the compelling future it builds for them to stay.”
Read the full article below.
The Strategic Depletion of Ghana Health Sector Human Capital copy
